Case of Coccidioidal Granuloma

The following case is unusual and interesting in that it adds some features to the data of a disease which may still be considered rare. As far as we have learned, it is the first reported case observed in the state of Missouri. It is one of not more than three cases which did not originate in the San Joaquin Valley, Calif. Other features, such as the evident symmetrical location of the lesions in the muscles, the continuous fever, and the unusually high leukocyte count, are of especial interest. In all, about forty cases of coccidioidal granuloma have been reported in the literature. Dickson1states that thirty-five of these patients have been residents of California; three have visited the state. This is the third instance, so far as we know, in which the patient has never been in California. The first case came under the observation of Posadas in